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Am J Dis Child. 1947;74(4):447-455. doi:10.1001/archpedi.1947.02030010460004.
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THORACIC empyema has been treated by surgical drainage1 for many years, and until the advent of penicillin other methods of therapy were comparatively ineffective. Even with the use of the sulfonamide compounds surgical drainage was still believed paramount.2 The intrapleural and parenteral use of penicillin has recently reduced the necessity for surgical intervention.3 Although the results have been satisfactory in many instances, certain limitations have been noted. Recurrence4 of the empyema and failure to eliminate the cavity after sterilization5 have been reported. The incidence of these and other sequelae can be reduced if proper evaluation of the case is made before treatment is begun. Hirshfeld and associates6 established the following conditions as necessary for successful treatment of empyema with penicillin: The causative organism must be susceptible to penicillin; it must be possible for the penicillin instilled into the empyema cavity to come into contact


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